GN

Question 1

Management of tumour lysis syndrome

Answer 1

IVT
Rasburicase
- urate oxidase inhibitor = prevents stone formation in a highly acidic environment by inhibiting conversion of uric acid to allantoic acid

Question 2

Mechanism of radio contrast induced nephropathy

Answer 2

Intra-renal vasoconstriction
And
Tubular injury 2o cytotoxicity

Question 3

Urinalysis findings in GN

Answer 3

RBCs from a glomerular origin

• dysmorphic RBCs (>80%)
• RBC casts
• proteinuria (80% albumin)

Question 4

Minimal change disease

1. Nephrotic vs nephritic?
2. Endothelial, epithelial vs mesangial disease?

Answer 4

Nephrotic

Epithelial cell disease

Question 5

Minimal change disease

Histo?

Answer 5

LM normal

EM- flattened podocytes

Question 6

Nephrotic
LM normal
EM flattened podocytes

Answer 6

Minimal change disease

Question 7

Management of minimal change disease

Answer 7

Steroids

If steroid resistant, Cyclophosphamide

Question 8

FSGS

1. Nephrotic vs nephritic?
2. Endothelial, epithelial vs mesangial disease?

Answer 8

Proteinuria (50% nephrotic)
+/- haematuria

Epithelial cell disease

Question 9

FSGS

Histo?

Answer 9

LM - FSGS with mesangial deposition (hyalinosis)

Question 10

Management of FSGS

Answer 10

1st line - Pred 1-2mg/kg/day
2nd line - cyclophosphamide
3rd line - cyclosporin

Question 11

Most common cause of nephrotic syndrome?

Answer 11

In children = minimal change disease

In adults = 1. Diabetic nephropathy 2. Membranous nephropathy 3. FSGS

Question 12

Membranous nephropathy

1. Nephrotic vs nephritic?
2. Endothelial, epithelial vs mesangial disease?

Answer 12

Nephrotic

Epithelial cell disease

Question 13

Membranous nephropathy

Histo?

Answer 13

LM - thickened GBM
Silver stain- immune deposits within GBM (spikes/bubbly appearance)

Late - interstitial fibrosis

Question 14

Management of membranous nephropathy

Answer 14

1st line - Pred and Cyclophosphamide for 6/12
2nd line - Cyclosporin or (Tac & Pred)

AND

Anti coagulate (warfarin) if serum albumin

Question 15

Cause of membranous nephropathy?

Answer 15

M-type phospholipase A2 receptor (PLA2R)

Question 16

Mesangioproliferative GN

1. Nephrotic vs nephritic?
2. Endothelial, epithelial vs mesangial disease?

Answer 16

Nephritic and nephrotic

Endothelial cell disease

Question 17

Mesangioproliferative GN

Histo?

Answer 17

LM - reduplication of the GBM due to splitting of the membrane by IgG deposits = train tracking/wire loops; cellular proliferation; interstitial damage

Question 18

What are the causes of secondary MPGN?

Answer 18

1. SLE

2. Hepatitis

Question 19

Management of MPGN?

Answer 19

Aspirin +/- dipyridamole

ACE-I

Question 20

IgA nephropathy/HSP

1. Nephrotic vs nephritic?
2. Endothelial, epithelial vs mesangial disease?

Answer 20

Nephritic (may have nephrotic range proteinuria)

**synpharyngitic

Mesangial cell disease

Question 21

What is the most common cause of glomerulonephritis?

Answer 21

IgA nephropathy

Question 22

What is the most common cause of ESRF requiring RRT due to a GN disease?

Answer 22

IgA nephropathy

Question 23

IgA nephropathy

Histo?

Answer 23

LM - mesangial hypercellularity & hyalinosis

EM - IgA immune complexes in the mesangium

Late - interstitial fibrosis and casts 🌙

Question 24

Management of IgA nephropathy

Answer 24

ACE-I

Prednisolone ONLY if (1) superimposed minimal change disease, or (2) proteinuria >1g/day

Fish oil ONLY if GFR

Question 25

Causes of rapidly progressive GN

Answer 25

1. ANCA assoc vasculitis 2. Anti-GBM disease 3. SLE

Question 26

Management of rapidly progressive GN

Answer 26

``` Pulse Methylpred then high dose PO Pred + Cyclophosphamide + Plasmapheresis (for ANCA & anti-GBM) ```

Question 27

Classes of lupus nephritis

Answer 27

``` 1- minimal disease 2- mesangial disease (deposits/proliferation) 3- focal proliferative GN 4- diffuse proliferative GN 5- membranous GN/sclerosis ```

Question 28

Features of HUS

Answer 28

1. Haematological thrombotic microangiopathy (thrombocytopenia and evidence of haemolysis) 2. End organ damage (proteinuria/decreased GFR; Neuro - stroke/delirium; GIT - pain/pancreatitis; cardiac or VTE/PE)

Question 29

Amyloid nephropathy 1. Nephrotic vs nephritic? 2. Endothelial, epithelial vs mesangial disease?

Answer 29

Nephrotic GBM dysfunction

Question 30

Amyloid nephropathy Histo?

Answer 30

Congo red stain - yellow coloured amyloid plaques surrounding GBM

Question 31

What is rapidly released into the circulation in tumour lysis syndrome?

Answer 31

K PO4 Ca Uric acid